455406235-5-19-2023-13-CC-JHEN-CRYNTP-20230519104504

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455406235
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:45:08 AM

Document Has Been Signed on 05/19/2023 10:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	SCOE - GRAND OAKS STATE PRESCHOOL		FACILITY NUMBER:	455406235
ADMINISTRATOR:	GONZALES, ANDREA		FACILITY TYPE:	850
ADDRESS:	5309 GRAND AVE. ROOM #1		TELEPHONE:	(530) 276-9479
CITY:	SHASTA LAKE CITY	STATE: CA	ZIP CODE:	96019
CAPACITY:	22	CENSUS: 14	DATE:	05/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jennifer Pore		TIME COMPLETED:	10:50 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 5/19/2023 at 9:15 AM, an annual inspection was made to the facility by Licensing Program Analyst (LPA), J. Helton. Shasta County Office of Education and a Title 5 funded program. Operation hours are 8:15 AM to 11:45 AM, Monday–Friday. The facility was toured at 10:45 AM inside and outside and the floor and yard plan submitted by the licensee were verified. Facility operates in room 1. The Facility representative, 3 additional teachers/aids were supervising 14 children, and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises.

6 children's records were reviewed at 9:26 AM. 3 staff records were reviewed at 9:40 AM.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Continued on LIC809C

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie Helton	TELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: SCOE - GRAND OAKS STATE PRESCHOOL	FACILITY NUMBER: 455406235
	VISIT DATE: 05/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

There were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Facility representative Jennifer Pore.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jackie Helton	TELEPHONE: 530-513-0993
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2